CMS Price Transparency Data

Physical therapy (gait training)

Facility: Perham Health

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $47
Cash Discount Price: $85
vs. Medicare Baseline: 1.62x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Perham Health is $47. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $85. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.62x the Medicare baseline. Located in 1000 Coney Street West, Perham, MN.

Cash / Self-Pay

$85

Average discount available for prompt cash payment at this facility.

Insurance Median

$47

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$29.06

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $29.06 (100%)

Cash / Self-Pay: $85 (292%)

Insurance Median: $47 (162%)

Cash: $85 (292% of Medicare)

Ins. Median: $47 (162% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $29.06 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Blue Cross Blue Shield	$36 - $89	124%
Health Partners Mcr Adv	$45	155%
Humana	$45	155%
Medica Mcr Adv	$45	155%
Medicare (plans)	$45 - $50	155%
Ucare Mn Senior Health Options	$45	155%
UnitedHealthcare	$46 - $102	158%
Medicaid / KanCare	$47	162%
Ucare Mn Medical Assistance	$47	162%
Ucare Mn Minnesota Care	$47	162%
Ucare Mn Senior Care Plus	$47	162%
Ucare Mn Special Needs Basic Care	$47	162%
Ucare Mn Special Needs Basic Care Dual	$47	162%
Medica Mcaid Mn Care	$48	165%
Medica Mn (Msho)	$54	186%
Ucare Individual And Family Plan-All Other Plans	$54	186%
Medica Mn Senior Hp/Outside Mn	$60	206%
Health Partners Minnesota Care	$66	227%
Medica Commercial-All Other Plans	$96	330%
Preferred One (Pchp, Pic, Pas)-All Other Plans	$98	337%
Health Partners-All Plans	$107	368%
Preferred One (Ppo)	$111	382%
Sanford Health Plan-All Plans	$111	382%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $85.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97116.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Perham Health is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97116.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.